Insurance
As people with chronic diseases we often run into people, companies, or organizations. Those people or organizations often frustrate or even enrage us. I know because they often enrage me. The rules, regulations, policies, procedures and protocol are simply sometimes so upsetting it makes us want to explode with anger.
A few months ago, I needed to order resupplies for my pump. I had to answer 40 questions before I could even make my order. It was enough to drive a sane man well less than happy. Then of course when one multiplies that by the 4 companies I would talk with that day my frustration was over the top. I bet if you are reading this blog you have been there as well.
One thing that is different about my experience is that I have been on the other side of these conversations. In a former life, I used to make the very rules that frustrate us so much. I also helped people work through the maze of rules and regulations that I and others put into place. So here is some advice.
First, these seemingly ridiculous rules likely have a reason. Many seem dumb, sometimes even worse than dumb they seem manufactured to make people angry. This is not the case, but we have to acknowledge that a rule is a nothing until it is enforced and it is the often the enforcement that creates the frustration. People enforce rules, so no matter how well written rules are not always well enforced.
Second, rules are never written one at time. All health insurance rules are written as part of a package deal. Once a salesperson tried to sell me group health insurance that excluded diabetic treatments and supplies, his logic was correct, sick people drive up rates. Of course he had no idea I was a type 1 diabetic and he was at a loss when I told him to get out of my office before I had security remove him. Still this is how most of these decisions are made. Had I simply been shopping for price it might have looked attractive.
Third, there is no insurance. Health insurance companies calculate premiums based on annual losses or gains. If a group has lots of claims next year the rate will go up a lot. If they have fewer costs the price of insurance will go up less. But there is no free lunch. It all balances next year and every penny counts. One interesting fact is that most insurance companies lay off risk to other larger insurance companies. So when a company has insurance from XYZ company, that company will purchase risk insurance from different companies to protect themselves from paying the full extent of the cost of the plan.
Fourth, health insurance trend is as important and sometimes more important than actual costs. Think of trend as expected health care inflation. In years past trend has run as high as 30% and as low as 8% in my area. Trend is the automatic unofficial tax we all pay on health care costs. I have never see trend go down and I have seen it go up as much as 40%. Typical trend is 20% in this market place. That is a built in 20% increase in rates before changes are even made.
Fifth and finally, Employers attempt to lower trend by taking away benefits. But sometimes seemingly large changes yield few results. Things like raising deductibles help a little but few things will do the whole job. Managers try to do the best they can, but they know it is dammed if you and dammed they don’t. You raise or lower these things and you hope for the best.
I hope this clarifies some of the mysteries of why we get so frustrated with why we do not always understand or get along with our health insurance companies. Yes I know I still get upset, but maybe you can pass on some knowledge next time you are ready to get really angry.
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Rick